ORCID Profile
0000-0003-1241-9303
Current Organisations
NIDCAP Federation International
,
Western Sydney University
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Publications
Ethical advocacy based on caring: a model for neonatal and paediatric nurses.
Publisher: Wiley
Date: 09-2011
DOI: 10.1111/J.1440-1754.2011.02178.X
Abstract: Advocacy has been identified as an ideal in nursing practice. National codes (Australian Nursing and Midwifery Council) and professional standards (Australian College of Neonatal Nurses) state that nurses are to respect their patients' autonomous choices and act as their advocates. This responsibility includes acting as advocates for the needs and welfare of patients, for the profession of nursing and for the interests of colleagues in nursing. However, ambiguous interpretations of the concept of patient advocacy continue to pose a number of problems for nurses in practice and in particular neonatal practice. Neonatal nurses often perceive themselves primarily as advocates for the rights of helpless and vulnerable infants in their care. Advocacy is underpinned by caring, which is a significant feature in the delivery of quality care for each baby and child. This advocacy may be expressed at the bedside, in committee meetings, in agency discussions or in the public arena.
What is the definition of acute episodic and chronic pain in critically ill neonates and infants? A global, four-stage consensus and validation study
Publisher: BMJ
Date: 03-2022
DOI: 10.1136/BMJOPEN-2021-055255
Abstract: To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU). A qualitative descriptive mixed-methods design. Each stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1 stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios. In stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively). This four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU.
Ethical Issues for Neonatal Nurses
Publisher: SAGE Publications
Date: 05-1998
DOI: 10.1177/096973309800500304
Abstract: This article examines the involvement of neonatal nurses in ethical issues, achieved through a survey of Australian neonatal nurses. The aim was to discover if nurses were involved in ethical decisions, to examine various categories of neonates and the concerns that nurses felt about them, and to determine the extent to which nurses saw themselves as advocates. A response rate of 65% was achieved from nurses in two states who worked in intensive care and special care nurseries. The findings show that nurses were more likely to be involved in clinical decision making than in ethical decision making, showed the greatest concern for infants who had an uncertain prognosis, and saw themselves as advocates for their patients. The issues surrounding these findings are examined.
Fathers’ needs in a surgical neonatal intensive care unit: Assuring the other parent
Publisher: Public Library of Science (PLoS)
Date: 06-05-2020
Engagement, reciprocity and advocacy: ethical harm reduction practice in research with injecting drug users
Publisher: Wiley
Date: 09-2006
DOI: 10.1080/09595230600876606
Abstract: In this paper, we contribute to the ethical challenges of harm reduction-based research by describing and reflecting on our experiences of initiating and maintaining relationships with research participants during an innovative neighbourhood-based study of the social and molecular epidemiology of the hepatitis C virus among injecting drug users over a 2-year period. We show through ex les of our work how recruitment to our study had practical value for both researchers and study participants including advocacy and reciprocity. We argue that the recruitment process needed to be flexible, able to cope with the demands of the street drug market, and that we as researchers need to engage participants in their own environments as much as possible. We conclude with a series of recommendations for other researchers such as the need to employ appropriately skilled researchers who are flexible, innovative and comfortable in street settings, and for the setting of realistic time-frames for preliminary research, data collection and feedback and analysis.
Gastro-oesophageal reflux: a mixed methods study of infants admitted to hospital in the first 12 months following birth in NSW (2000–2011)
Publisher: Springer Science and Business Media LLC
Date: 12-02-2018
Excision duodenoplasty: a new technique for congenital duodenal obstruction
Publisher: Springer Science and Business Media LLC
Date: 2002
Abstract: Slow anastomotic function is a common problem in the management of congenital duodenal obstruction. We describe a simple technique of excision duodenoplasty (ED) that results in a fixed open anastomosis, which facilitates early commencement of feeds and discharge from hospital. A retrospective case-note review (1981-2000) was undertaken to compare the results of ED with side-to-side duodenoplasty (SSD) and diamond-shaped anastomosis (DD). The outcome measures were days to commencement of feeds, duration of total parenteral nutrition (TPN), and length of hospital stay. In ED a 1.0 to 1.5-cm elliptical segment of dilated duodenum is excised. A longitudinal incision is made in the smaller distal duodenum. A side-to-side one-layer anastomosis is performed. The wall of the proximal duodenal stump is thick, and excision of the ellipse keeps the anastomosis open by preventing apposition of the opposing walls. This facilitates good drainage across the anastomosis. The time to onset of feeding was longer after SSD (median 7 days) compared to ED (5 days) and DD (5 days). The total duration of TPN was also longer for SSD (9 days) in comparison to ED (7 days) and DD (7 days). Although the duration of hospital stay was more for SSD (18 days) than ED (13 days) and DD (16 days), this difference was not statistically significant. The ED technique thus gives an equally good result as DD and a better result than SSD. It is simple to perform and to teach.
Inter-observer reliability in reading amplitude-integrated electroencephalogram in the newborn intensive care unit.
Publisher: Wiley
Date: 07-06-2017
DOI: 10.1111/JPC.13589
On the Qualitative in Drugs Research: Part Two
Publisher: Informa UK Limited
Date: 2001
Qualitative social research in addictions publishing: Creating an enabling journal environment
Publisher: Elsevier BV
Date: 11-2010
The best interest principle as a standard for decision making in the care of neonates
Publisher: Wiley
Date: 06-2000
DOI: 10.1046/J.1365-2648.2000.01402.X
Abstract: In neonatal care, decisions are made on behalf of newborn infants by their parents or, in some instances, health professionals. This paper examines how the best interest standard is the most appropriate focus for decision-making concerning neonates. The components of surrogate decision-making are discussed from the perspective of the neonate's interests and the contribution of the various persons involved in caring for neonates. An argument is presented for the use of best interests when making decisions and the interpretation of best interests is explored. By examining the ethical approaches using best interests, an argument is put forward for caring as an expression of best interests. How some nurses use the best interest standard in their practice is described. The unique perspective nurses may have because of their philosophy, circumstances, experience and concern for neonates is discussed. Ex les are used from the literature to support the argument for nurses being in roles and relationships where the neonate's interests are the basis of practice. How nurses classify infants on the basis of their future outcome is used to illustrate how nurses can apply the best interest standard. Ethical approaches of care and cure are used to show the best interest standard as applied to neonates. Caring as an expression of best interests is recommended for nursing decisions and actions using infant outcomes as a focus for caring and best interests.
Do neonatal nurses′ perceptions agree with parents’ self-reported needs and stressors in a surgical neonatal intensive care unit?
Publisher: Elsevier BV
Date: 02-2023
The effects of nurse-delivered caregiving in the neonatal setting: An integrative review
Publisher: Elsevier BV
Date: 10-2021
A Cross-sectional Survey of Enteral Feeding Tube Placement and Gastric Residual Aspiration Practices
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-01-2021
DOI: 10.1097/ANC.0000000000000822
Abstract: Preterm infants routinely require enteral feeding via nasogastric or orogastric tubes as an alternative to oral feeding to meet their nutritional needs. Anecdotal evidence suggests variations in practice related to correct tube placement and assessment of feed intolerance. To determine the current practices of enteral feeding tube placement confirmation and gastric residual (GR) aspiration of neonatal clinicians in Australia. A cross-sectional online survey comprising 24 questions was distributed to nursing and medical health professionals working in Australian neonatal care units through 2 e-mail listservs made available by professional organizations. The survey was completed by 129 clinicians. A single method was practiced by 50% of the clinicians in confirming tube placement, and most common practice was assessing the pH of GR aspirate. The majority of respondents (96%) reported that they relied on GR aspiration and clinical signs to determine feeding tolerance and subsequent decisions such as ceasing or decreasing feeds. However, the frequency of aspiration, the amount and color of aspirate considered to be normal/abnormal, and decisions on whether to replace gastric aspirate or whether aspiration should be performed during continuous tube feeding varied. This study demonstrated considerable variability in clinical practice for enteral feeding tube placement confirmation and GR aspiration despite most respondents reporting using a unit-based clinical practice guideline. Our study findings highlight the need for not only developing evidence-based practice guidelines for safe and consistent clinical practice but also ensuring that these guidelines are followed by all clinicians. Further research is needed to establish evidence-based methods both for enteral feeding tube placement confirmation and for the assessment of feeding intolerance during tube feeding. In addition, the reasons why evidence-based methods are not followed must be investigated.
Learning how we learn: an ethnographic study in a neonatal intensive care unit
Publisher: Wiley
Date: 06-2008
DOI: 10.1111/J.1365-2648.2008.04632.X
Abstract: This paper is a report of a study to identify how nurse clinicians learn with and from each other in the workplace. Clinicians' everyday practices and interactions with each other have recently been targeted as areas of research, because it is there that quality of care and patient safety are achieved. Orientation of new nurses and doctors into a specialty unit often results in stress. An ethnographic approach was used, including a 12-month period of fieldwork observations involving participation and in-depth interviews with nurse, doctor and allied health clinicians in their workplace. The data were collected in 2005-2006 in a paediatric teaching hospital in Australia. The findings were grouped into four dimensions: orientation of nurses, orientation of medical registrars, preceptoring and decision-making. The orientation of new staff (nursing and medical) is a complex and multi-layered process which accommodates multiple kinds of learning, in addition to formal learning. Workplace learning also can be informal, incidental, interpersonal and interactive. Interactive and interpersonal learning and the transfer of knowledge include codified and tacit knowledge as well as intuitive understandings of 'how we do things here'. Research into how nurses learn is crucial for illuminating learning that is non-formal and less recognized than more formal kinds. To provide a safe practice environment built on a foundation of knowledge and best practice, there needs to be an allocation of time in the busy workday for learning and reflection.
Neonatal surgery in New South Wales—What is performed where?
Publisher: Elsevier BV
Date: 07-2003
DOI: 10.1016/S0022-3468(03)00184-2
Abstract: The aim of this study was to describe what surgical procedures are performed in the neonatal period in New South Wales (NSW) and where they are performed. Population-based descriptive study was conducted in NSW in a 2-year period from July 1, 1996 to June 30, 1998, inclusive, using information from the NSW Health Department's Inpatient Statistics Collection. All neonates undergoing major surgery (excluding circumcisions) in NSW. In the first 4 weeks of life, 990 (0.6%) neonates underwent surgery. The most common surgical procedures were gastrointestinal, cardiovascular, hernia, genitourinary, and neurosurgical. Frenotomy accounted for 5% of all surgical procedures. Whereas 75% of neonatal surgery (including 88% of gastrointestinal and 97% cardiovascular surgery) occurs in children's hospitals, only 13% of the babies requiring surgery are born in the co-located obstetric hospitals. Perinatal centers accounted for 5.3% of surgery urban hospitals for 8.4% rural hospitals, 5.5%, and private hospitals, 6.4%. The mortality rate in the neonatal period was 3.0% overall. This is the first review of major neonatal surgery in Australia and provides baseline data for future comparisons. Whereas most neonates had surgery in a children's hospital, few of them were born in the most appropriate place, the co-located obstetric hospital. Parents should be informed of the level of institutional surgical expertise and be involved in the decision-making regarding the place of surgery for their infant. Parents and children have a right to expect the best possible results.
Measuring nursing workload in neonatal intensive care
Publisher: Hindawi Limited
Date: 04-2006
DOI: 10.1111/J.1365-2934.2006.00609.X
Abstract: To determine if a suitable method of measuring nursing workload could be developed in neonatal intensive care units (NICUs). Nursing is a multifunctioning activity and previous methods measuring the demand for nurses do not put enough emphasis on the in idual capabilities. The reporting of NICU activity has traditionally been related to bed occupancy and the number of infants requiring ventilator support. A classification system based on activity, hours of care and nursing staff ratios has been used however, it does not consider the clinical ability of the in idual nurses. A 5-month prospective study was undertaken in which nurses in two NICUs scored their patients' level of dependency and professional assessment of the level of intensity of care required by the infants in each shift. In addition, serial measures of severity of illness scores for each patient were collected. The study identified methods of measuring workload that consider the in idual nurse's ability and contributing organizational factors. We found that the estimates of nursing hours using the two traditional dependency measures did not match the current practice or take into account the skill of the nurses. A method in which the nurses indicated the intensity of nursing care required by their patients was suitable one for capturing their in idual capabilities. System factors were also found to contribute to the nursing workload. It is not sufficient to use patient acuity or severity of illness alone. Other factors such as the nurse's assessment of the intensity of care required and the organizational factors are important components of workload estimates.
Local wound analgesia in infants undergoing thoracic or abdominal surgery
Publisher: Wiley
Date: 27-01-2025
Procedural pain in neonates in Australian hospitals: A survey update of practices
Publisher: Wiley
Date: 21-12-2013
DOI: 10.1111/JPC.12064
Abstract: The study aims to determine whether there has been improved uptake of the evidence for the management of procedural pain in neonates throughout Australia. An Australian-wide survey was undertaken to determine the use of breastfeeding and sucrose and whether a clinical practice guideline (CPG) or pain assessment tool was used. Data were available from 196 (91%) of the 215 eligible hospitals. A CPG informed the management of neonatal pain in 76 (39%) of the hospitals. There was wide variation in their use between the states, and a significantly higher use of a CPG in higher-level care units. A pain assessment tool was only used in 21 (11%) of the units with greater use in the higher level care neonatal intensive care units (50%) and surgical neonatal intensive care units (80%). Awareness of breastfeeding for procedural pain was reported by 90% of the 196 respondents while 78% reported that it was actually used. Awareness of sucrose for procedural pain was lower than breastfeeding at 79%, with 53% reporting that they used sucrose in their unit. Overall, 89% of the respondents reported that either breastfeeding or sucrose was used for the management of procedural pain in their units. There has been an increase in awareness and use of sucrose and breastfeeding for procedural pain in Australia since previous surveys were undertaken in 2004. Continued resources, local pain ch ions and a national interest group to promote the use of pain management for procedural pain in neonates are needed for continued uptake of the evidence.
Delivery in the ‘grey zone’: Collaborative approach to extremely preterm birth
Publisher: Wiley
Date: 11-07-2007
Extending total parenteral nutrition hang time in the neonatal intensive care unit: Is it safe and cost effective?
Publisher: Wiley
Date: 17-12-2012
DOI: 10.1111/JPC.12023
Abstract: To investigate the effects of prolonging hang time of total parenteral nutrition (TPN) fluid on central line-associated blood stream infection (CLABSI), TPN-related cost and nursing workload. A before-after observational study comparing the practice of hanging TPN bags for 48 h (6 February 2009-5 February 2010) versus 24 h (6 February 2008-5 February 2009) in a tertiary neonatal intensive care unit was conducted. The main outcome measures were CLABSI, TPN-related expenses and nursing workload. One hundred thirty-six infants received 24-h TPN bags and 124 received 48-h TPN bags. Median (inter-quartile range) gestation (37 weeks (33,39) vs. 36 weeks (33,39)), mean (±standard deviation) admission weight of 2442 g (±101) versus 2476 g (±104) and TPN duration (9.7 days (±12.7) vs. 9.9 days (±13.4)) were similar (P > 0.05) between the 24- and 48-h TPN groups. There was no increase in CLABSI with longer hang time (0.8 vs. 0.4 per 1000 line days in the 24-h vs. 48-h group P < 0.05). Annual cost saving using 48-h TPN was AUD 97,603.00. By using 48-h TPN, 68.3% of nurses indicated that their workload decreased and 80.5% indicated that time spent changing TPN reduced. Extending TPN hang time from 24 to 48 h did not alter CLABSI rate and was associated with a reduced TPN-related cost and perceived nursing workload. Larger randomised controlled trials are needed to more clearly delineate these effects.
Influence of patterns of neonatal transfers on breastfeeding outcomes
Publisher: Wiley
Date: 27-05-2021
DOI: 10.1111/JPC.15530
Abstract: To investigate/evaluate the impact of hospital transfers on breastfeeding outcomes for infants requiring neonatal intensive care and to explore approaches to supporting lactation and breastfeeding. A national study of two cohorts of infants admitted to the nine neonatal intensive care units (NICUs) in New South Wales (NSW) Australia using data sourced from a prospectively collected NICUS data collection. A total of 7829 infants were admitted to the nine NICUs in NSW for two 18‐month cohorts (2012/2013 and 2015/2016) and were included in the study. These infants experienced 17 238 transfers to 107 different hospitals during the study period. Multiple transfers and low gestational age were independently associated with lower breastfeeding rates at hospital discharge across both cohorts. Extremely preterm infants and those with the greatest number of hospital transfers are least likely to be breastfed at time of discharge. Breastfeeding rates remained unchanged over time. The level of lactation support varied across NICUs. This study highlights the challenges of establishing and maintaining breastfeeding for infants requiring intensive care who have had multiple hospital transfers for continuing or specialist care. There is wide variation in lactation support across facilities. The importance of a consistent approach, education programmes and the provision of appropriate lactation support is emphasised.
Tri- (M = Cu II ) and hexanuclear (M = Ni II , Co II ) heterometallic coordination compounds with ferrocene monocarboxylate ligands: Solid-state structures and thermogravimetric, electrochemical and m
Publisher: Elsevier BV
Date: 12-2017
Salivary cortisol measurements in sick infants: A feasible and objective method of measuring stress?
Publisher: Elsevier BV
Date: 06-2005
Individualised developmental care for babies and parents in the NICU: Evidence-based best practice guideline recommendations
Publisher: Elsevier BV
Date: 12-2019
Closing the evidence-practice gap for newborn pain using clinical networks.
Publisher: Wiley
Date: 21-11-2010
Exploration and Validation of Behavioral Pain Measures and Physiological Pain Measures Factor Structure Extracted From the Pain Assessment Tool Item Scores for Infants Admitted to Neonatal Intensive C
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-03-2021
DOI: 10.1097/AJP.0000000000000931
Abstract: The objective of the study was to explore and then validate the factor structure of the Pain Assessment Tool (PAT). A retrospective medical record review was performed of all infants who were admitted to a neonatal intensive care unit between 2008 and 2018 and had 1 PAT assessment (n=2111). Scores on items of the PAT were collected. Infants were randomized to either the principal component analysis (n=1100) to explore the factor structure or confirmatory factor analysis (n=1011). Infants in the 2 s les were demographically comparable. A 2-factor model, consisting of factors Behavioral and Physiological Pain Measures, was extracted, explaining 39.8% of the total variance. There was a low interfactor correlation ( r =0.12), and both Behavioral ( r =0.59) and Physiological Pain ( r =0.37) Measures factor scores were correlated with nurses’ perception of pain scores. When the frequencies in the gestational age at birth categories were compared between upper and lower quartile score infants, there was more with pain at preterm than at term (χ 2 (3)=44.9, P .001) for the Physiological Pain Measures factor, whereas Behavioral Pain Measures frequency was higher at term than at preterm (χ 2 (3)=8.1, P .043). A similar pattern was observed for postmenstrual age at assessment categories: Behavioral Pain Measures (χ 2 (3)=41.8, P .001) Physiological Pain Measures (χ 2 (3)=46.1, P .001). The 2-factor correlated model performed better at explaining the observed variances: (χ 2 (13)=41.6, P .001) compared with rival models. The PAT assesses both Behavioral Pain and Physiological Pain Measures, and these dimensions need to be considered separately when assessing pain in infants in the neonatal intensive care unit. Behavioral item scores may be insufficient for detecting pain in premature infants if used alone.
Needs of parents in a surgical neonatal intensive care unit
Publisher: Wiley
Date: 04-10-2018
DOI: 10.1111/JPC.14249
Abstract: While there is evidence of parental needs in the neonatal intensive care unit (NICU), parents of newborns admitted for general surgery are an under-researched population. This study aimed to identify needs in parents of newborns admitted to the NICU for general surgery and whether health-care professionals meet these needs. This was a prospective cohort study of 111 parents (57% mothers) of newborns admitted to a surgical NICU for general surgery in Australia from January 2014 to September 2015. Parents completed the Neonatal Family Needs Inventory (NFNI), comprising 56 items in five subscales (Support, Comfort, Information, Proximity, Assurance) at admission and discharge, as well as the Social Desirability Scale (SDS). Data were analysed using parametric and non-parametric techniques. At both admission and discharge, parents rated Assurance (M = 3.8, standard deviation (SD) = 0.24) needs as the most important, followed by Proximity (M = 3.6, SD = 0.32) and Information (M = 3.5, SD = 0.38). Mothers rated Assurance significantly more important than fathers (P < 0.02). Overall, parents' most important needs were having questions answered honestly (M = 3.96, SD = 0.19), seeing their infant frequently and knowing about the medical treatment (both M = 3.95, SD = 0.23). The 10 most important needs were met for more than 96% of parents, with no evidence of response bias. Reassurance is a priority need for parents in the surgical NICU. Mothers' and fathers' needs may be best met by practices based on family-centred, in idualised care principles.
One- and Two-Triplon Spectra of a Cuprate Ladder
Publisher: American Physical Society (APS)
Date: 12-01-2007
Nasal versus oral intubation for mechanical ventilation of newborn infants
Publisher: Wiley
Date: 26-04-1999
‘Untangling the web of critical incidents’: Ethnography in a paediatric setting
Publisher: Informa UK Limited
Date: 02-07-2008
DOI: 10.1080/13648470802122016
Abstract: Critical incidents (CIs) are the elements that bring about an alert or wake up call for clinicians in hospital wards. They are considered critical because the safety of patients, staff or visitors is at risk. Not all CIs result in dire consequences, nor do they require Root Cause Analysis (RCA). Nonetheless, incidents affect patients and involve clinicians' interactions with each other. This paper describes the complexities embedded in two CIs in a major paediatric hospital in Australia. An anthropological ethnographic research approach enabled the researcher to observe, document, interpret and make sense of the activities of clinicians in two different clinical areas of the hospital, i.e., the Rehabilitation Unit and the Neonatal Unit (NU). Ethnographic research significantly exposes and highlights hospital dramas and shows the effects on clinicians' everyday lives. We suggest that CIs have two dimensions: a medical and a social. The medical dimension encompasses factors in the treatment and care of the patient. The social dimension encompasses the social relationships and the socio-affectivity (emotional responses and labour) of treating clinicians. Our main argument is that foregrounding of the socio-cultural dimensions of CIs informs and impacts on the medical dimensions. Our conclusions demonstrate that the social dimensions of CIs have important ramifications for clinical interactions in everyday practices and these impact on the positive learning of clinicians after a CI has occurred.
On the Qualitative in Drugs Research: Part One
Publisher: Informa UK Limited
Date: 2001
Systematic review and meta‐analysis suggest that varying prevalence of non‐acute pain in critically ill infants may be due to different definitions
Publisher: Wiley
Date: 26-08-2019
DOI: 10.1111/APA.14956
Abstract: Our aim was to quantify the prevalence of non-acute pain in critically ill infants and to identify how non-acute pain was described, defined and assessed. This systematic review and meta-analysis used multiple electronic databases to search for papers published in any language to March 2018: 2029 papers were identified, and 68 full texts were screened. Studies reporting the prevalence of non-acute pain in infants younger than 2 years and admitted to critical care units were included. The extracted data included the use of non-acute pain descriptions, definitions and pain assessment tools. We included 11 studies published between 2002 and 2018 that comprised 1204 infants from Europe, the USA, Canada and India. They were prospective observational (n = 7) and retrospective observational (n = 1) studies and randomised controlled trials (n = 3). The prevalence of non-acute pain was 0%-76% (median 11%). Various pain assessment tools were used, and only two could be pooled. This gave a pooled prevalence of 3.7%-39.8%. A number of different descriptors were used for non-acute pain, and all of these were poorly defined. The prevalence of non-acute pain in infants admitted to critical care units varied considerably. This could have been because all the studies used different definitions of non-acute pain.
Local wound analgesia in infants undergoing thoracic or abdominal surgery
Publisher: Wiley
Date: 27-05-2021
Early development of children with major birth defects requiring newborn surgery
Publisher: Wiley
Date: 21-11-2010
DOI: 10.1111/J.1440-1754.2010.01902.X
Abstract: To describe neurodevelopmental outcomes of neonates following cardiac or non-cardiac surgery for major birth defects. From 1 June 2002 to 31 July 2004, infants born ≥ 33 weeks gestation who underwent major birth defect surgery were enrolled prospectively. Infants were assessed at a mean corrected age of 24 months (standard deviation (SD) = 8 months, range 18-36 months) using the Bayley Scales of Infant Development: Second Edition. Of the 118 study infants, 79 (66%) were male, the mean gestation was 38.5 weeks (SD 1.9 weeks) and mean birthweight was 3194 g (SD 653 g). Forty-five infants (47%) had undergone general surgery for non-cardiac defects. The majority of infants (73%) performed below average in cognitive and language skills. Mental delay was found in 41% of infants 16% were significantly delayed. Fine and gross motor skills were below average in 60% of infants. Twenty-six percent of infants had motor delay 9% were significantly delayed. Both the mean Mental Development Index (M = 88, SD = 19.8) and mean Psychomotor Development Index (M = 93, SD = 19.3) were significantly below the normative mean (d = 0.8, P < 0.001 and d = 0.5, P < 0.001, respectively). One in five children had global developmental delay. There was no significant difference in outcome between the cardiac and general surgery groups. The majority of infants performed below average on a standardised test of infant development. Our results show that infants requiring newborn surgery for major birth defects are at high risk of adverse neurodevelopmental outcomes. We recommend that follow-up programmes include systematic multidisciplinary developmental monitoring and early intervention.
Neonatal medical trainee doctors' perceptions and parents' self‐reported needs and stressors in a surgical neonatal intensive care unit: An individualised approach
Publisher: Wiley
Date: 02-11-2021
DOI: 10.1111/JPC.15819
Abstract: As more infants survive surgery in the newborn period for major congenital anomalies, the focus has shifted to the quality of care for parents as well as infants. In contemporary neonatal intensive care units (NICUs), doctors are encouraged to practice family‐centred care and partner with parents in their infant's care. This study explored doctors' perceptions and parents' self‐reported needs and stressors in a surgical NICU. From January 2014 to September 2015, parents of infants admitted for general surgery for a major congenital anomaly who were present in the NICU between 48 and 72 h of admission and doctors caring for their infant at the time of data collection were invited to participate. Matched data were provided using the Neonatal Family Needs Inventory and the Parental Stressor Scale:NICU. Matched data for 12 doctor–parent dyads showed that doctors (neonatal medical trainees) consistently under‐rated the importance of parents' needs and identified fewer of mothers' than fathers' most important needs. Doctors also consistently under‐rated parents' stressors. They perceived few of fathers', but all of mothers', greatest stressors. Thematic analysis revealed four themes: infant pain management parental autonomy empathy and communicating reassurance and education to parents. The findings suggest incongruences between doctors' perceptions and parents' self‐reported needs and stressors. While there is hesitation in making recommendations with this s le size, the findings highlight issues that may inform further research and contribute to a dialogue regarding the role of doctors in family‐centred relationship‐based models of care in the NICU.
Responses to a special issue
Publisher: Elsevier BV
Date: 02-2003
Evidenced-based clinical practice guideline for management of newborn pain
Publisher: Wiley
Date: 27-04-2010
Challenges in conducting prospective research of developmentally directed care in surgical neonates: A case study
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1016/J.EARLHUMDEV.2011.08.003
Abstract: Evaluation is fundamental to evidence-based practice. Due to practical constraints inherent in real-world clinical environments, however, innovations in clinical practice are often implemented without rigorous research. We set out to evaluate the effectiveness of developmentally directed care in surgical neonates using a randomised controlled trial with a Newborn In idualized Care and Assessment Program (NIDCAP) intervention. The aim of this paper is to inform future studies by sharing lessons learnt in conducting prospective research of a practice-intervention in a critical care setting. Three intervention components were used to assess implementation: number of NIDCAP observations infant allocation to project nurses, and consistency of care. Barriers to implementation were identified through discussions with nurses who had key roles. Insufficient episodes of NIDCAP observation and infant allocation to project nurses, and lack of consistency of care indicated that the intervention had not been successfully implemented. Barriers to implementation (fast 'turnover' of patients, unpredictable changes in medical status, staff/skill shortages, and inconsistent care) were attributed to the competing demands between service provision and research in a busy critical care context. The findings regarding barriers to successful implementation of NIDCAP in this case study are relevant to any critical care setting where complex interventions are under consideration, as similar challenges are plausible across a range of clinical contexts. Adopting a critical methodologically-informed approach to appraise implementation and evaluate complex interventions is essential.
Mother–child interaction and child developmental capacities in toddlers with major birth defects requiring newborn surgery
Publisher: Elsevier BV
Date: 12-2010
DOI: 10.1016/J.EARLHUMDEV.2010.08.025
Abstract: Evidence exists of the important role of the mother-child relationship in child development, yet with the exception of prematurity, little is known of the impact of biologic risk on this relationship. We investigated the quality of the mother-child interaction in association with early development in toddlers who had newborn surgery for major birth defects. Ninety-three toddlers (Mean age=24.7 months, SD=4.6) requiring newborn surgery for major birth defects, underwent developmental testing and participated in a videotaped free play interaction with their mothers. Interactions were rated using the National Institute of Child Health and Human Development schema. Interaction ratings were compared with normative data and within group differences were also examined in relation to child developmental status. Overall mean interaction ratings were suboptimal and significantly different from normative data with the exception of child negative mood. Forty-one children (44%) had developmental delay. Mother and child interactive behaviour ratings were consolidated into three factors (Maternal Responsivity, Maternal Intrusiveness, and Child Positive Interactivity) for multivariate analyses. Compared to children developing normally, those with developmental delay showed significantly less positive interactivity and had mothers who were less responsive and more intrusive. Child behaviour with the tester was related to child behaviour with the mother. Quality of mother-child interaction is nonoptimal in children with major birth defects requiring newborn surgery. Mothers of infants with developmental delay are most at risk of interaction difficulties and may benefit from early identification and timely intervention.
Needs and stressors of parents of term and near-term infants in the NICU: A systematic review with best practice guidelines
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.EARLHUMDEV.2019.104839
Abstract: Having a sick infant in the NICU can be quite stressful and overwhelming to parents. They require support and may have varied needs. A systematic review of qualitative and quantitative studies from 5 electronic databases (Ovid Medline, EMBASE, PsycINFO, CINAHL and Sociological Abstracts), covering January 2001 - March 2016 identified the needs and stressors of parents of term or near-term Infants in the NICU. Six articles addressed the needs and 14 identified the stressors of parents. Parents' most important need was for accurate and honest information. Needs focused around sensitive infant care and involvement in decision-making. The greatest stressor for parents was alteration to the parental role, followed by infant appearance. Fathers and parents of infants undergoing surgery are an under-researched population. Based on the evidence, enhancing staff-parent communication would better meet parental needs and reduce stressors. Our key recommendations highlight the need for family-centred and in idualised care practices in the NICU.
Trajectories of post-surgical pain in infants admitted to neonatal intensive care
Publisher: Wiley
Date: 20-07-2020
DOI: 10.1002/EJP.1629
The effects of education levels of developmental care in Australia: Perceptions and challenges
Publisher: Elsevier BV
Date: 04-2017
Infant well-being following neonatal cardiac surgery
Publisher: Wiley
Date: 23-05-2011
DOI: 10.1111/J.1365-2702.2011.03716.X
Abstract: Aims and objectives. To investigate infant well‐being as measured by feeding and sleeping and parental support following discharge from the NICU in infants following major cardiac surgery. Background. Infant feeding and sleeping have been identified as two of the most important concerns reported by parents. These concerns have been reported anecdotally for infants who have undergone cardiac surgery in the neonatal period. Design. A prospective study using questionnaires and phone interviews followed a cohort of parents of neonates who underwent surgery in the neonatal period for congenital heart disease. Methods. The study was conducted using validated questionnaires and phone interviews with a semi‐structured questionnaire. The questionnaires were administered prior to discharge from the NICU and interviews took place following discharge on five occasions within nine months. Results. Fifty six infants and mothers were followed for nine months following discharge from NICU. Sixty‐eight per cent were breastfeeding on discharge however the rates decline over time in line with healthy infants. Mothers were not bothered by their infant’s sleep patterns which were consistent with those of healthy infants at six months. There were 37 episodes of re‐hospitalisation and the average time of further surgery was five months following discharge from their initial period of hospitalisation. Conclusion. The issues from this pilot study warrant further investigation. Factors such as multiple hospitalisations, parent education and support may vary within contexts and need to be studied to ensure optimal supports are identified for this high risk population. Relevance to clinical practice. This study identified several issues that can improve care provided to these infants and their parents. Support following discharge could include: lactation consultant to provide follow‐up calls to identify concerns with breastfeeding, lactation course for paediatric nurses providing follow‐up and education for Early Childhood Clinics on Congenital Heart Disease.
Interaction of an extended series of N-substituted di(2-picolyl)amine derivatives with copper(II). Synthetic, structural, magnetic and solution studies
Publisher: Royal Society of Chemistry (RSC)
Date: 2009
DOI: 10.1039/B901832H
Abstract: The interaction of Cu(II) with the following secondary N-substituted derivatives of di(2-picolyl)amine () are reported: N-cyclohexylmethyl-di(2-picolyl)amine (), N-benzyl-di(2-picolyl)amine (), N-(4-pyridylmethyl)-di(2-picolyl)amine (), N-(4-carboxymethylbenzyl)-di(2-picolyl)amine (), N-(9-anthracen-8-ylmethyl)-di(2-picolyl)amine (), 1,3-bis[di(2-picolyl)aminomethyl]benzene (), 1,4-bis[di(2-picolyl)aminomethyl]benzene () and 2,4,6-tris[di(2-picolyl)amino]triazine (). The solid complexes [Cu()(micro-Cl)](2)(PF(6))(2), [Cu()(micro-Cl)](2)(PF(6))(2).0.5CH(2)Cl(2), Cu()(ClO(4))(2), Cu()(2)(ClO(4))(2), [Cu()(ClO(4))(2)(H(2)O)].0.5H(2)O, Cu(2)()(ClO(4))(4), [Cu(2)()(Cl)(4)] and [Cu(2)(+H)(micro-OCH(3))(2)(H(2)O)](ClO(4))(3).C(4)H(10)O were isolated and X-ray structures of [Cu()(micro-Cl)](2)(PF(6))(2), [Cu()(micro-Cl)](2)(PF(6))(2).0.5CH(2)Cl(2,) [Cu()(2)(ClO(4))(2)(H(2)O)].0.5H(2)O, [Cu(2)()Cl(4)] and [Cu(2)(+H)(micro-OCH(3))(2)(H(2)O)](ClO(4))(3).C(4)H(10)O were obtained. The series is characterised by a varied range of coordination geometries and lattice architectures which in the case of [Cu()(ClO(4))(2)(H(2)O)].0.5H(2)O includes a chain-like structure formed by unusual intermolecular pi-interactions between metal bound perchlorate anions and the aromatic rings of adjacent anthracenyl groups. Variable temperature magnetic susceptibility measurements have been performed for [Cu()(micro-Cl)](2)(PF(6))(2) and [Cu()(micro-Cl)](2)(PF(6))(2).0.5H(2)O over the range 2-300 K. Both compounds show Curie-Weiss behaviour, with the data indicating weak antiferromagnetic interaction between the pairs of copper ions in each complex. Liquid-liquid (H(2)O/CHCl(3)) extraction experiments involving and as extractants showed that, relative to the parent (unsubstituted) dipic ligand , substitution at the secondary amine site in each case resulted in an increase in extraction efficiency towards Cu(II) (as its perchlorate salt) at least in part, this increase may be attributed to the enhanced lipophilicities of the N-substituted derivatives.
Pain and Stress in the NICU.
Publisher: Routledge
Date: 11-2019
Topical anaesthesia for needle-related pain in newborn infants
Publisher: Wiley
Date: 04-02-2017
Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants.
Publisher: John Wiley & Sons, Ltd
Date: 21-07-2003
Global neonatal nurses identify research priorities for improving neonatal outcome
Publisher: Elsevier BV
Date: 04-2021
Nursing scripts and the organizational influences on critical thinking: report of a study of neonatal nurses' clinical reasoning
Publisher: Wiley
Date: 05-2000
DOI: 10.1046/J.1365-2648.2000.01378.X
Abstract: During 1995-1997 a study was undertaken to explore the extent to which theoretical knowledge acquired through a distance education programme in neonatal nursing was brought to bear in the real-world clinical reasoning of course participants. The study utilized a think aloud technique and included both concurrent (on-the-job) and retrospective verbal reports at 0, 6 and 12 months into the programme. Participants (n=4) were also interviewed in idually on completion of the study. Results indicated that important inconsistencies existed between participants' theoretical knowledge and their practice they also pointed to some organizational influences on these theory-practice inconsistencies. Script (or schema) theory provided a useful explanatory framework for these results. The paper includes a brief description of data collection and analysis techniques its main emphasis, however, is on these theory-practice inconsistencies and their explanation in terms of the nature and acquisition of nursing practice scripts. The implications of nursing scripts for the promotion of critical thinking and evidence-based practice are discussed.
Development of a Foundation Protocol for Feeding Complex Care Neonates and Enablers and Barriers to Its Implementation
Publisher: Informa UK Limited
Date: 25-04-2022
Social theory in drug research, drug policy and harm reduction
Publisher: Elsevier BV
Date: 12-2004
An innovative program to close the gap from research to practice: A clinical neonatal nursing fellowship
Publisher: Elsevier BV
Date: 04-2015
Stress and distress in parents of neonates admitted to the neonatal intensive care unit for cardiac surgery
Publisher: Elsevier BV
Date: 12-2016
DOI: 10.1016/J.EARLHUMDEV.2016.08.002
Abstract: Parents of infants admitted to the Neonatal Intensive Care Unit (NICU) are at risk of psychological distress and NICU-related stress. However, parents of infants admitted to NICU for cardiac surgery are an under-researched population. Identify levels of NICU-related stress, and levels of psychological distress, reported by parents of infants admitted to the NICU for cardiac surgery. Observational study. 69 parents of infants admitted to the NICU for cardiac surgery (cardiac group) and 142 parents of healthy infants (control group). Questionnaire packs provided to parents prior to discharge (time-point 1), and at six and 12months corrected age included: Hospital Anxiety and Depression Scale, Coping Inventory for Stressful Situations, and Family Support Scale. The Parental Stressor Scale:NICU was administered to the cardiac group at time-point 1. The cardiac group reported (i) that parental role alteration was the most stressful aspect of the NICU and (ii) higher scores for anxiety and depression than the control group at all three time-points, with the highest levels reported during the NICU stay. Correlation analyses indicated (i) stress associated with the sights and sounds of the NICU, and the appearance and behaviour of the infant in the NICU, had a significant positive association with anxiety and depression, and (ii) a significant negative relationship between anxiety and task-focused coping. An in idualised parent-targeted intervention aimed at reducing stress associated with the NICU and enhancing task-focused coping style may help to reduce levels of anxiety and depression within this group of parents.
Decreasing infection in neonatal intensive care units through quality improvement
Publisher: BMJ
Date: 02-05-2016
DOI: 10.1136/ARCHDISCHILD-2015-310165
Abstract: To decrease the incidence of bloodstream infection (BSI) for neonates <29 weeks gestation through quality improvement. Commencing in September 2011, eight neonatal intensive care units (NICUs) in New South Wales and Australian Capital Territory, Australia participated in the Sepsis Prevention in NICUs Group project, a multicentre quality improvement initiative to reduce neonatal infection through implementation of potentially better practices and development of teaching resources. Data were collected for neonates <29 weeks gestation from D3 to 35, using point of care data entry, for BSI, central line-associated BSI (CLABSI) and antibiotic use. Exponentially weighted moving average data trend lines for rates of BSI, CLABSI and antibiotic use for each NICU were automatically generated and composite charts were provided each month to participating NICUs. Between January 2012 and December 2014, data were collected from D3 to 35 for 1075 neonates 48 h, for a total of 33 933 bed days and 14 447 central line days. There was a significant decrease from 2012 to 2014 in BSI/1000 bed days (7.8±3.0 vs 3.8±1.1, p=0.000), CLABSI/1000 bed days (4.6±2.1 vs 2.1±0.8, p=0.003), CLABSI/1000 central line days (9.9±4.3 vs 5.4±1.7, p=0.012) and antibiotic days/100 bed days (31.1±4.3 vs 25.5±4.2, p=0.046). This study demonstrates a >50% reduction in BSI in extremely premature neonates from D3 to 35 following a collaborative quality improvement project to reduce neonatal infection across an NICU network, supported by timely provision of data.
Gastroschisis: determinants of neonatal outcome
Publisher: Springer Science and Business Media LLC
Date: 03-04-2003
DOI: 10.1007/S00383-002-0886-0
Abstract: This retrospective study elicits information regarding the dependence of neonatal outcome in gastroschisis upon: (1) the mode of delivery, (2) place of birth, (3) time for birth to surgery, (4) method of closure, (5) time from operation to commencement of first enteral feeds. The neonatal intensive care database from five major tertiary centres was used to identify 181 neonates with gastroschisis from 1990 to 2000. There were 8 deaths. There were no significant differences in outcome for infants delivered vaginally (102) versus Caesarean section (79), those born near the tertiary centre (133) as compared to infants born away (48), ones operated within 7 hours (125) compared with those operated after 7 hours (56), with delayed closure (30) versus primary closure (151). Neonates fed within 10 days of operation (85) had significantly lower incidence of sepsis, duration of TPN and hospital stay when compared to those fed after 10 days (96). Early commencement of feeds decreases the incidence of sepsis, duration of total parenteral nutrition (TPN) and hospital stay. Place of delivery, mode of delivery, time to surgery and type of closure do not influence neonatal outcome.
Differences in attitudes to feeding post repair of Gastroschisis and development of a standardized feeding protocol
Publisher: Springer Science and Business Media LLC
Date: 12-2019
DOI: 10.1186/S12887-019-1858-Z
Abstract: The purpose of this study was to examine differences in attitudes to feeding in neonates with Gastroschisis between clinical groups and to develop a standardized feeding protocol. Confusion, inconsistencies in practice and lack of evidence could be contributing to avoidable delays in the establishment of enteral feeds resulting in lengthy requirements for central venous access, dependence on total parenteral nutrition (TPN), increased risk of sepsis, TPN related cholestasis and prolongation in length of hospital stay. A national survey of clinicians (neonatologists, neonatal intensive care nurses and paediatric surgeons), looking after neonates with gastroschisis was undertaken to determine differences in feeding practice post repair. In addition, an audit of practice in one hospital was undertaken to examine variations in practices between clinicians. A feeding protocol was then developed using inputs from surgeons and neonatologists. Gastric aspirates and residuals were typically used as indicators of feed readiness and feed tolerance however, there was very little consistency within and between clinical groups in definitions of tolerance or intolerance of feeds and in how to initiate and progress feeds. A feeding protocol with clear definition of feed readiness and a clear pathway to progression of feeds was developed to help overcome these variations in practice with the possibility that this might reduce the length of stay (LOS) and have other secondary benefits. The protocol included early introduction of enteral feeds particularly direct breast or sucking feeds. Wide differences in attitudes to feeding neonates post Gastroschsis repair exist and the need for a consistent protocolized approach was felt. The feeding protocol we developed requires a change of practice and further clinical trials are needed to evaluate its effectiveness.
Be Sweet to Babies
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-09-2023
ACCURACY OF WEIGHING SIMULATED INFANTS WITH IN-BED AND FREESTANDING SCALES WHILE CONNECTED AND DISCONNECTED TO A VENTILATOR
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2003
Abstract: To develop an accurate method of weighing ventilated infants in the clinical setting. Two dolls that simulated ventilated infants were adapted to different weights ranging from 745 to 3,995 g. Four methods of weighing ventilated infants were evaluated. The study design used multiple clinical nurses, randomly chosen, to weigh the simulated infants. Freestanding and in-bed scales were used with a simulated ventilated infant being either connected or disconnected from the ventilator tubing for the procedure. The mean weights of the simulated infants measured in the incubator, with or without the ventilator connected, had a mean difference of +/- 2 g from the gold standard. However, the mean weights of the simulated infants measured on the freestanding scales were 12 g < the gold standard of industry calibrated weights (P < 0.001). The measurement error was small both with and without the ventilator connected. This error was proportionally very small for weights over 1,500 g, but was increased for weights < 1,500 g. The use of in-bed scales was the most accurate method of weighing simulated infants of all weight categories. This study shows the importance of a consistent and meticulous technique when weighing infants in intensive care. The accuracy of weights is enhanced with the use of in-bed scales, and this is particularly significant in infants less than 1,500 g.
The Evolution of an Interdisciplinary Developmental Round in a Surgical Neonatal Intensive Care Unit
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-05-2020
DOI: 10.1097/ANC.0000000000000741
Abstract: Developmentally supportive environments are known to improve medical outcomes for hospitalized neonates and are considered the overarching philosophy for practice in the neonatal setting. Developmental rounds are a strategy incorporated by multidisciplinary teams to support development within and beyond the neonatal unit. Typically, they consist of bedside consultations and in idualized developmentally supportive recommendations for families and clinicians. Globally, the use of developmental rounds has been described since the early 1990s. They are viewed as a measure to counter some of the barriers to developmental care implementation while buffering against the effect of an intensive care admission. To date, their use in the surgical neonatal intensive care unit (sNICU) has been minimally reported in literature. This article describes the focus and work of a developmental round team and strategy in the sNICU. A retrospective audit of developmental round key performance criteria undertaken over a 4-year period (2015-2018). More than 300 developmental consults and 2000 in idualized developmental recommendations occurred annually. Parental presence during the developmental round increased by 10%, from 48% to 58%, during the audit period. Literature has supported the use of developmental round interventions however, minimal data have been reported to date. This article provides retrospective audit data of a developmental round intervention in the sNICU with a focus on data over 4 years to highlight key areas, including the structure and process, recommended educational standards for team members, and parental engagement, as key markers for developmental round efficacy. Future research should focus on the link between the developmental round intervention and long-term neonatal outcomes.
Neonates as intrinsically worthy recipients of pain management in neonatal intensive care
Publisher: Springer Science and Business Media LLC
Date: 09-10-2021
Parents' awareness and use of nonpharmacological methods to manage their baby's procedural pain in a surgical neonatal intensive care unit
Publisher: Elsevier BV
Date: 02-2023
Measuring nursing unit culture as an empirical basis for implementing a model of practice in a neonatal intensive care unit
Publisher: Elsevier BV
Date: 02-2006
Deep versus shallow suction of endotracheal tubes in ventilated neonates and young infants.
Publisher: Wiley
Date: 06-07-2003
Call for neonatal nursing specialization in developing countries
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2013
Knowledge and learning in speciality practice
Publisher: Elsevier BV
Date: 12-2016
The impact of a police crackdown on a street drug scene: evidence from the street
Publisher: Elsevier BV
Date: 09-2002
Stressors of parents of infants undergoing neonatal surgery for major non‐cardiac congenital anomalies in a surgical neonatal intensive care unit
Publisher: Wiley
Date: 27-11-2019
DOI: 10.1111/JPC.14673
Abstract: As more babies survive major neonatal surgery, the quality of life of the whole family is a major focus of health care. While there is evidence suggesting that parents of babies admitted to neonatal intensive care units (NICUs) experience high levels of stress, little is known about stressors in parents whose infants also require neonatal surgery. This study identified fathers' and mothers' stressors in a surgical NICU. Parents of infants admitted for general surgery to the NICU at a tertiary children's hospital from February 2014 to September 2015 were eligible for enrolment. Parents completed the Parental Stressor Scale: NICU to measure levels of stress related to three subscales: sights and sounds, infant appearance and parental role alteration, using a 5-point Likert scale. Data for 111 parents (57% mothers) showed parental role alteration as the greatest stressor for parents (M = 2.98, standard deviation (SD) = 0.89), particularly for mothers, followed by infant appearance (M = 2.84, SD = 0.95). Both fathers and mothers rated feeling helpless (M = 4.1, SD = 1.0), unable to protect their baby (M = 4.1, SD = 0.9) and seeing their baby in pain (M = 3.9, SD = 1.2) the most common, most stressful experiences and highest contributors to overall stress in the surgical NICU environment. Parental role alteration is the greatest stressor for parents in the surgical NICU. Reducing stress for parents of infants undergoing neonatal surgery requires management of the infant's pain and strategies to support parents in their role in the NICU.
A reliable pain assessment tool for clinical assessment in the neonatal intensive care unit
Publisher: Elsevier BV
Date: 2005
Abstract: The aim of this study was to validate a clinician-friendly pain assessment tool for all groups of critically ill infants cared for in the specific neonatal intensive care units (NICUs) studied. A prospective study was undertaken to test the Pain Assessment Tool (PAT). Interrater reliability of the PAT score was assessed by two nurses who simultaneously determined an infant's PAT score. The PAT was validated against the CRIES score--crying, requires increased oxygen administration, increased vital signs, expression, sleeplessness--and the mother's assessment of her infant's discomfort using the Visual Analogue Scale (VAS). The NICUs at two children's hospitals. Participants were 144 preterm and term infants. Infants on a ventilator and those who had undergone surgery were included. The interrater reliability of the PAT was .85 with a mean difference of 0.17 (standard deviation: 1.73). There was a strong correlation between the PAT and CRIES scores (r = 0.76) and a moderate correlation (.38) between the PAT score and the VAS scores of the infant's mother. The correlation coefficient between the PAT score and CRIES score was significant for all groups (p < .01). The PAT score was shown in this study to be a valid, reliable, and clinician-friendly pain assessment measurement tool for all infants nursed in the NICU.
Related Organisations
Colorado NIDCAP Training Center, USA
Location: United States of America
Related Funding Activities
The Emotional And Social Burden Of Caring For A Young Child With Complex Health Needs
Start Date: 2008
End Date: 2012
Funder: Australian Research Council
View Funded Activity